Cardiovascular outcomes with etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison

@article{Cannon2006CardiovascularOW,
  title={Cardiovascular outcomes with etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison},
  author={Christopher P. Cannon and Sean P. Curtis and Garret A. FitzGerald and Henry Krum and Amarjot Kaur and James A. Bolognese and Alise S. Reicin and Claire Bombardier and Michael E. Weinblatt and D{\'e}sir{\'e}e van der Heijde and Erland Erdmann and Loren Laine},
  journal={The Lancet},
  year={2006},
  volume={368},
  pages={1771-1781}
}
BACKGROUND Cyclo-oxygenase-2 (COX-2) selective inhibitors have been associated with an increased risk of thrombotic cardiovascular events in placebo-controlled trials, but no clinical trial has been reported with the primary aim of assessing relative cardiovascular risk of these drugs compared with traditional non-steroidal anti-inflammatory drugs (NSAIDs. [...] Key MethodMETHODS We designed a prespecified pooled analysis of data from three trials in which patients with osteoarthritis or rheumatoid arthritis…Expand

Paper Mentions

Interventional Clinical Trial
The purpose of this study is to investigate which pain mechanisms that can be affected by etoricoxib compared to placebo (inactive medication)in subjects with painful knee… Expand
ConditionsOsteoarthritis
InterventionDrug
Interventional Clinical Trial
The study is designed to compare the risk of cardiovascular events (heart attacks, strokes) in patients receiving either etoricoxib or diclofenac. It will also compare the… Expand
ConditionsRheumatoid Arthritis,Osteoarthritis
InterventionDrug
Interventional Clinical Trial
The purpose of this study is to evaluate the long-term safety of an investigational drug versus an approved drug for the relief of pain in patients with rheumatoid arthritis.  
ConditionsRheumatoid Arthritis
InterventionDrug
Interventional Clinical Trial
The purpose of this study is to compare the gastrointestinal tolerability of an investigational drug to an approved drug in the treatment of osteoarthritis during one year… Expand
ConditionsOsteoarthritis
InterventionDrug
Assessment of upper gastrointestinal safety of etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison
TLDR
There were significantly fewer upper gastrointestinal clinical events with the COX-2 selective inhibitor etoricoxib than with the traditional NSAID diclofenac due to a decrease in uncomplicated events, but not in the more serious complicated events. Expand
Gastrointestinal tolerability of etoricoxib in rheumatoid arthritis patients: results of the etoricoxib vs diclofenac sodium gastrointestinal tolerability and effectiveness trial (EDGE-II).
TLDR
Etoricoxib 90 mg demonstrated a significantly lower risk for discontinuing treatment due to GI AEs compared with diclofenac 150 mg, and resulted in similar efficacy. Expand
Relative benefit-risk comparing diclofenac to other traditional non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors in patients with osteoarthritis or rheumatoid arthritis: a network meta-analysis
TLDR
The benefit-risk profile of diclofenac was comparable to other treatments used for pain relief in OA and RA; benefits and risks vary in individuals and need consideration when making treatment decisions. Expand
Etoricoxib: a review of its use in the symptomatic treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and acute gouty arthritis.
TLDR
The drug was associated with fewer uncomplicated upper gastrointestinal adverse events than nonselective NSAIDs, and was noninferior to diclofenac in terms of the rate of thrombotic cardiovascular events. Expand
Cardiovascular safety and gastrointestinal tolerability of etoricoxib vs diclofenac in a randomized controlled clinical trial (The MEDAL study).
TLDR
Long-term etoricoxib use is associated with a risk of thrombotic CV events comparable with that of diclofenac, but a greater risk of renovascular AEs but a more favourable GI/liver tolerability profile. Expand
A Comparison of Cardiovascular Biomarkers in Patients Treated for Three Months with Etoricoxib, Celecoxib, Ibuprofen, and Placebo
TLDR
Etoricoxib was comparable to placebo, celecoxib, and ibuprofen for effects on the CV risk markers measured, and was not different from Placebo, cele Coxib, or ibup rofen for any biomarker. Expand
Efficacy and safety of etoricoxib in the treatment of osteoarthritis
  • A. Sebba
  • Medicine
  • Expert review of clinical pharmacology
  • 2008
TLDR
Large-scale studies addressing the efficacy, GI tolerability and potential for CV events with etoricoxib have now been published, and several patient types appear to benefit, including those with CV risk factors and those requiring gastroprotective agents. Expand
Comparative evaluation of cardiovascular outcomes in patients with osteoarthritis and rheumatoid arthritis on recommended doses of nonsteroidal anti-inflammatory drugs
TLDR
It appears that the risk for cardiovascular events in arthritis patients on licensed doses of NSAIDs varies considerably and is likely to depend on the individual compound. Expand
Rationale, design, and governance of Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen Or Naproxen (PRECISION), a cardiovascular end point trial of nonsteroidal antiinflammatory agents in patients with arthritis.
TLDR
The first study of patients with high cardiovascular risk chronically treated with a cyclooxygenase-2 selective inhibitor or nonselective NSAID will define the relative cardiovascular safety profile of celecoxib, ibuprofen, and naproxen and provide data to help guide NSAID use for pain management for this population. Expand
Etoricoxib versus naproxen in patients with rheumatoid arthritis: a prospective, randomized, comparator-controlled 121-week trial
TLDR
A two-part extension of the initial 12-week treatment study found that etoricoxib was more effective than naproxen or placebo in treating rheumatoid arthritis was performed to monitor tolerability and examine long-term efficacy. Expand
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TLDR
The MEDAL program will help to better define the risk-to-benefit ratio of 2 NSAIDs, that differ in their selectivity for COX-2, notably diclofenac and etoricoxib. Expand
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COMPARISON OF UPPER GASTROINTESTINAL TOXICITY OF ROFECOXIB AND NAPROXEN IN PATIENTS WITH RHEUMATOID ARTHRITIS
A BSTRACT Background Each year, clinical upper gastrointestinal events occur in 2 to 4 percent of patients who are taking nonselective nonsteroidal antiinflammatory drugs (NSAIDs). We assessedExpand
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